One of President Obama’s constant refrains during the battle over health reform has been that expanding coverage would reduce inefficiency in the system. In particular, he often cited expensive expensive emergency room visits as something that reform could help reduce. But it turns out, Obamacare, like Romneycare before it, is likely to increase emergency visits, maybe substantially.
MIT News reports on a newly published Harvard study of Medicaid users in Oregon:
Adults who are covered by Medicaid use emergency rooms 40 percent more
than those in similar circumstances who do not have health insurance,
according to a unique new study, co-authored by an MIT economist, that
sheds empirical light on the inner workings of health care in the U.S.
Emergency room visits are many times more expensive than primary care visits for similar treatment. This is why, both before and after health reform was passed, politicians cited reducing emergency room visits as a reason the law was a good idea.
Wonkblog cites two examples today, Republican Gov. Rick Snyder and HHS Secretary Sebelius who said back in 2009 “Our health care system has forced too many uninsured Americans to depend on the emergency room for the care they need.”
But perhaps the person who has made this case more than anyone else is President Obama. He has repeatedly said over the past six years that reform would reduce ER visits thereby creating greater efficiency in the system (i.e. saving us money). Below are 17 examples:
- Nov 8, 2013 – “You know, one of the reasons to do it is — I have said this before.
Sometimes people don’t fully appreciate it. We already pay for the
health care of people who don’t have health insurance. We just pay for
the most expensive version, which is when they go to the emergency room.” - Oct. 30, 2013 – “we pay more in premiums and taxes when Americans without good insurance visit the emergency room. (Applause.) We get taxed.”
- Oct 1, 2013 – “we should not have a system in which people are regularly going to the
emergency room, driving up costs for everybody else, because they
haven’t acted responsibly.” - April 30, 2013 – “we would rather have people getting regular checkups than going to the
emergency room because they don’t have health care — if — if we keep
that in mind, then we’re going to be able to drive down costs, we’re
going to be able to improve efficiencies in the system” - July 17, 2012 – “If you don’t have health care, then we’re going to help you get it. And
the only people who may have a problem with this law are folks who can
afford health care but aren’t buying it, wait until they get sick and
then going to the emergency room and expecting everybody else to pick up
the tab. That’s not responsibility.” - June 28, 1012 – “when uninsured people who can afford coverage get sick, and show up at
the emergency room for care, the rest of us end up paying for their care
in the form of higher premiums.” - April 3, 2012 – “we shouldn’t have a system in which millions of people are at risk of
bankruptcy because they get sick, or end up waiting until they do get
sick, and then go to the emergency room, which involves all of us paying
for it.” - Mar 15, 2010 – “she didn’t want to be in a position where, if she did get sick, somebody
else would have to pick up the tab; that she’d have to go to the
emergency room; that the cost would be shifted onto folks through their
higher insurance premiums or hospitals charging higher rates.” - March 3, 2010 – “taxpayers currently end up subsidizing the uninsured when they’re forced
to go to the emergency room for care, to the tune of about a thousand
bucks per family. You can’t get those savings if those people are still
going to the emergency room.” - Feb 2, 2010 – “we want to make sure that everybody has health insurance, which in turn
allows us to cut back on some wasteful spending and help upgrade
hospitals and doctors and how they perform medicine because now they’re
not dealing with as many emergency room patients.” - Dec 9, 2009 – “Today, millions of Americans still have difficulty accessing primary
health care, and many of them are uninsured…So
they don’t get regular checkups, they don’t get routine screenings.
When they get sick or hurt, they tough it out and hope for the best, and
when things get bad enough they head to the emergency room. So we end up treating complications, crises and chronic conditions that could have been prevented in the first place.” - Sep 17, 2009 – “if there are affordable options and people don’t sign up, then the rest
of us pay for somebody else’s expensive emergency room care. And that’s
not fair.” - Sep 9, 2009 – “those of us with health insurance are also paying a hidden and growing
tax for those without it — about $1,000 per year that pays for somebody
else’s emergency room and charitable care.” - Aug 14, 2009 – “if we can help provide coverage to people so that they’re getting
regular primary care and they’re not going to the emergency room, we
will obtain some savings and that’s partly…that’s partly how we’ll end up paying for giving people
health insurance — because we’re already paying for it right now, we
just don’t notice it.” - July 22, 2009 – “the average American family is paying thousands of dollars in hidden
costs in their insurance premiums to pay for what’s called uncompensated
care, people who show up at the emergency room because they don’t have a
primary-care physician.” - Jun 5, 2008 – Sleep deprived Obama on the campaign trail:
- Jan 25, 2007 – “They tell us it’s too expensive to cover the uninsured, but they don’t mention that every time an American without health insurance walks into an emergency room, we pay even more.”
Obviously if Obamacare raises the number of emergency room visits by 40 percent, that isn’t saving us money. Even if insured visits cost less on average than uninsured visits, it wouldn’t still not be a move in the right direction (according to the President).
There were a few people pointing out back in 2010 that this method of cost control was probably illusory. Massachusetts, which served as a model for Obamacare, also saw increased emergency room visits after reform.